Advice

Juan1961
Juan1961 Member Posts: 5 Member
edited July 19 in Prostate Cancer #1

Advice: 63-year-old asymptomatic patient. I was given the following three options for localized prostate cancer.

1.Laparoscopic prostatectomy preserving left side nerves

2. Radiation

3. Active Surveillance

HISTORY:

11-09-2018 PSA 3.9

05-15-2024 PSA 7.8

05-19-2024 Biopsy: 6 cores, 3 from the left side (chronic prostatitis), 3 from the right side (Gleason 6 (3+3)).

06-26-2024 MRI

FINDINGS:

Urinary Bladder: No lesions within the bladder.

Prostate: The prostate has a lobulated contour, measuring 5.0 x 2.5 x 3.2 cm in transverse, anteroposterior, and craniocaudal axes, with an approximate weight of 20 grams. The peripheral zone shows a markedly hypointense focus on ADC, hyperintense on DWI, with hypervascularity on dynamic sequences. This affects the right posterolateral segments of the apex and mid-third, measuring 1.0 x 1.4 cm in transverse (ADC) and craniocaudal (T2 sagittal) axes, without evidence of extraprostatic extension.

Transition Zone: No evidence of infiltrative lesion.

Seminal Vesicles and Ductus Deferens: No evidence of alteration.

Pelvis: No evidence of masses or collections, no evidence of adenomegaly.

Bone Structures: No evidence of suspicious lesions.

CONCLUSION

Prostate weighing 20 grams with a suspicious focus in the right peripheral zone corresponding to a PI-RADS 4. The presence of clinically significant cancer is probable.

Comments

  • Wheel
    Wheel Member Posts: 138 Member
    #2

    Juan,

    Little surprised they went straight to Biopsy and then did MRI. I hope the biopsy took cores from the suspicious focus area of the right peripheral zone. I would consider Active Surveillance (AS)for several reasons. You are young and it could be years before it needs attention and because of being young and not near 70, several years or more until treatment would still leave you a surgery option. Although following the guidance for AS would be essential with more Mri’s, likely biopsies and watching your PSA so it could be caught quickly if things changed. Second being young and possibly then doing AS gives you the highest quality of life for possibly years without enduring the side effects. Many people have have a hard time accepting the cancer is there and want it out. Remember of all the cancers this is one of the best to have as it typically does not turn on a dime. You have plenty of time to monitor it. I had non Hodgkin’s lymphoma (NHL)20 years ago and the Prostate AS was called Watch and wait then for NHL. It was also slow growing in the lymph nodes. I was scanned and blood work regularly but was able to put off ultimate treatment with chemotherapy for several years. Prostate cancer is known to grow much more slowly but again you want to be sure you are monitored. Additional biopsies to monitor it are nothing compared to side effect treatment protocols. I would choose a biopsy anytime if it then meant another year with no treatment. Many people are concerned with biopsies and I don’t understand how someone could be more concerned with a biopsy then treatment. As long as you are comfortable it would be caught take all the quality of life years available while you are younger. You are fortunate its a 6(3+3) and not a 7 (3+4) which is also offered AS. That would be a harder decision. These are just my thoughts and others report they just wanted the cancer out and are happy with their decisions.

  • Juan1961
    Juan1961 Member Posts: 5 Member
    #3

    Thank you very much for your thoughtful and detailed response. I truly appreciate the insights and personal experiences you shared regarding active surveillance (AS) for localized prostate cancer. 

    Your perspective on the importance of quality of life and the potential benefits of monitoring rather than rushing into treatment resonates with me. It’s reassuring to hear that, with careful monitoring through MRIs, biopsies, and PSA tests, AS can be a viable option that allows for timely intervention if necessary.

    Your comparison with non-Hodgkin’s lymphoma and the "watch and wait" approach provides valuable context and comfort. It’s encouraging to know that many people have successfully managed their condition with close monitoring and delayed treatment, maintaining a good quality of life.

    I also appreciate your emphasis on the slow-growing nature of Gleason 6 (3+3) prostate cancer and the flexibility it provides in considering treatment options. Your point about the relative ease and minimal impact of regular biopsies compared to the potential side effects of immediate treatment is well taken.

    Once again, thank you for your thoughtful advice and encouragement. Your insights have given me a lot to consider as I discuss my options with my healthcare team. 

    Best regards,

    Juan

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    #4

    I agree that Active Surveillance is the way to go for a case like yours. It may not last forever, but prostate cancer therapies are constantly evolving in a positive way.

    There are different Active Surveillance protocols; some are more strict than others. Personally, I would use a strict one.

    PS: I am surprised that only six cores were taken. I hope you paid less 😁

  • Wheel
    Wheel Member Posts: 138 Member
    #5

    juan

    Glad it helped. For me turning 71 in two months, and diagnosed in early March with five Gleason 6 (3+3) one Gleason 7 (3+4) and the one Gleason 8 (4+4) I had to move forward and make a decision. That one darn Gleason 8 is what all the Doctors with me said I needed to act. I am approaching upper age concerns for Surgery depending on health outlook and since overall still good, I head into Surgery in three weeks.

  • Juan1961
    Juan1961 Member Posts: 5 Member
    #6

    Wheel

    Thank you so much for sharing your personal experience and advice. Your insights have been invaluable as I navigate my own diagnosis and treatment options.

    I understand the urgency you faced with a Gleason 8 (4+4) diagnosis, and I appreciate you explaining the factors that led to your decision. It’s reassuring to hear that, despite the challenges, you’ve maintained good overall health and are able to proceed with surgery.

    Your willingness to share your journey and the considerations involved is incredibly helpful. It underscores the importance of individualized decisions based on specific medical circumstances and overall health outlook.

    I wish you all the best with your upcoming surgery and a smooth recovery. Thank you again for your support and guidance.

    Best regards,

    Juan

  • Juan1961
    Juan1961 Member Posts: 5 Member
    #7

    Old Salt

    Thank you for your insights and support regarding my prostate cancer diagnosis. I appreciate your recommendation for active surveillance and the reminder that prostate cancer therapies are continually improving.

    It's reassuring to know that there are different protocols for active surveillance, and I will certainly discuss with my healthcare team to ensure we choose a strict and effective one.

    As for the biopsy, to provide some context, I am living in Mexico and am under the care of the IMSS (Instituto Mexicano del Seguro Social), which is funded through contributions from workers, employers, and the government. The IMSS subrogated the 6-core biopsy, which actually cost $500 USD. And the pathology results were made by an IMSS pathologist. I will discuss the core count with my doctor to ensure thorough monitoring in the future.

    Thank you again for your valuable advice and encouragement.

    Best regards,

    Juan.

  • On_A_Journey
    On_A_Journey Member Posts: 132 Member
    #8

    @Juan1961, I also agree that AS is the best option for now, as long as you are rigid with it (meaning, quarterly blood tests and follow-ups) and that you are prepared to make a quick decision if things deteriorate.

    My PSA was 7.0 and Gleason 3+3 with a T1 staging when I was diagnosed, a few months later my PSA spiked to 10.6 and I underwent a radical prostatectomy. The surgical report revealed that Gleason was 3+4 and that I was at stage T3a. I was only 52 at the time (61 now).

    Things can develop quickly. Good luck.

  • Juan1961
    Juan1961 Member Posts: 5 Member
    #9

    Old Salt

    Thank you for your insights and support regarding my prostate cancer diagnosis. I appreciate your recommendation for active surveillance and the reminder that prostate cancer therapies are continually improving.

    It's reassuring to know that there are different protocols for active surveillance, and I will certainly discuss with my healthcare team to ensure we choose a strict and effective one.

    As for the biopsy, to provide some context, I am living in Mexico and am under the care of the IMSS (Instituto Mexicano del Seguro Social), which is funded through contributions from workers, employers, and the government. The IMSS subrogated the 6-core biopsy, which actually cost $500 USD. And the pathology results were made by an IMSS pathologist. I will discuss the core count with my doctor to ensure thorough monitoring in the future.

    Thank you again for your valuable advice and encouragement.

    Best regards,

    Juan.

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